Whatcha’ lookin for?

Author: Erin

As an ER nurse for the last several years I have learned that there is an incredibly broad definition of what constitutes an emergency. The lucky nurse who gets to triage on a Monday evening knows the frustration of triaging the 20th patient with some ridiculously minor complaint. I often get frustrated by the abuse of the emergency department and agitated with the amount of resources needed to care for these complaints, they clog up the waiting room!
After my last busy shift in triage, I began to really think why patients come to the ED with minor complaints. Why does one patient’s cold mean an emergency to them versus the patient who stumbles in with 10/10 crushing chest pain?
I am constantly asking patients “if this has been going on for x amount of time why is it an emergency today, what has changed that made you want to get evaluated?” By pointing out the lack of emergency their situation is I hope they will think twice next time before sitting in our waiting room for 4 hours to be evaluated for perceived purple boogers (seriously, that happened).
Not only do less than emergent patients clog up the waiting room but they also take away valuable resources. Patient’s often complain about long wait times, hurried nurses and doctors who “don’t really listen to them”, well when your staff is being spread so thin trying to take care of Mrs. M having an MI in room 21 and then the stubbed toe sitting in the hallway, I think any nurse would be a little frustrated. Wait times get long when nonsense complaints fill the department, each of these patients need to be evaluated and treated which takes away valuable time from the truly sick patients.
One of the ways I have learned to manage the ever-changing definition of an emergency is try to put a patient’s complaint into perspective, especially when they start to get ornery about sitting in a hallway or having an extended wait time to see a provider. I like to remind them that there are often very sick people in the department and if one of their family members was sick they would want all the staff’s attention on them. Sometimes patients get it and sometimes they don’t, often when they don’t understand it’s not worth your time or energy to try to argue because you have lives to save!
As frustrated we all get with Timmy toe pain for ten months, the variety these patients bring to the ED is the silver lining of emergency medicine. The variety we see shift after shift keeps it fresh and exciting, and lets all be honest, when you have three telemetry admits with new EKG changes, on heparin drips, the level 4 knee pain in the hallway is a welcome reprieve even if they do have Q2min snack and Percocet requests.
So, next time your frequent flyer knee pain comes through the doors, give them an honest perspective on their situation with a side of humor, compassion and respect but please, hold the narcotics (we don’t need to perpetuate the problem!).

I’m sure everyone has been there once in their life, waiting for what seems like forever to see a doctor. In doctor’s offices’ it is almost assumed that if your appointment is at 4PM you really will be seen at 4:45. However, it seems that when patients decide to register at their local ER their “emergency” is the ONLY one, not the 30 other people with their “emergency” sitting in the waiting room….so in order to blow off a little steam and maybe shine some light on WHY emergency department wait times can be so lengthy I’ve created my top few reasons:

1. Acuity – you know that back pain you have had for the past 6 months? Well hate to break it to you but that is not a life or death situation. However, that guy that you just watched and specifically point out to me that “hey that dude was here waayyyy after me and he just went in” well that guy, sir, was hit by a car at 30mph and any second now you will hear a trauma paged over head. I bet he has worse back pain than you.

2. Diagnostics – As nurses, we generally like to move our patients into and out of the department as fast as possible, however we are not responsible for labs ordered, ultrasounds, CT scans, MRI’s – any sort of imaging, we don’t have the student loans to back up those types of orders. All those tests take time, they allow staff to make the right decisions about your care. In the ER, bloodwork is drawn and resulted in about 45 minutes, radiology is completed and resulted in a few hours…imagine if you did that all on an outpatient basis – it would take WEEKS!

3. Communication – so the ER doc as decided you’re sick enough to win yourself an overnight in the hospital, whoo! Free hospital food! So although you think since you’re “admitted” it means a bed is ready and waiting for you with a RN at your beckon call you couldn’t be further from the truth. Now the MD who is going to be responsible for your care in the hospital has to come and evaluate you for themselves. then write orders, then put a bed order in, then if we are BOTH lucky you will get a bed assigned….

4. A bed is assigned, Great! Now you are no longer my problem, I’ve been getting tired of answering your call bell for a ginger ale when I am up to my eye balls in diarrhea in the room next door. Now comes the chore of attempting to call report to the receiving RN on whichever floor you are going to be staying. This process can take anywhere from 5 minutes to an hour, so when that room that you’re staying in could’ve been turned over for another patient, depending on the report process it might take that much longer.

5. Sick patients – The ICU in most hospitals has a patient to RN ratio of 2:1, in the ER, if we are LUCKY and it is a relatively slow day we have 5 patients, any number of those patients can be critical enough to go to the ICU. If I were caring for your Mom and she was intubated, being kept alive by 6 different drugs, wouldn’t you want all my attention to her? Yeah, I thought so. Sick patients are time consuming, they deserve to be. So while I am trying to take care of your dying Mother, the rest of my assignment is going to crap. All those people in the waiting room don’t care that I’m sweating my ovaries off sticking tubes in every orifice I can, they just want their stretchers and warm blankets out of the waiting room.

So, folks, next time you’re in the ER and are getting pissed about the wait time, think about it..could your emergency be solved Monday morning at the clinic or your primary? Also, please don’t yell at the staff, we get called every name in the book all day ‘er day, it gets old, it wears on your, it sucks your soul – treat us just like you would any other human. We are humans with families and this is our job, please respect us as much as we respect you.

As a new RN, I recently accepted my first night shift job working in the emergency department. I’ll be working the graveyard shift of 11 PM – 7AM and no I am not nuts. Working in the emergency department has always been a dream of mine and I’ve been incredibly fortunate to have the opportunitiy to do it so early in my nursing career. That being said, I was willing to take whatever crappy shift they would give me in order to get my foot in the door. I’ve been googling (pitiful how that’s not a commonly accepted verb) the sh*t out of night shift work, health, paleo, primal, Weston A. Price…all the hippie stuff and have come up with some strategies I’m going to try to implement to keep my sanity and health.

1. Keep the sugar to a minimum. Calories after midnight still count, even though those chick-flicks say they don’t, trust me…they do.

2. Sleep in a cave. I’ve started the process of turning my bedroom into a girl cave. Painted neutral grey walls, made my bed so cozy and working on ordering blackout curtains and shades.

3. Protect my sleep. I’ll be on a schedule opposite of normal humans so it’s going to be really important to say no to commitments and protect my 7-8 hours of dreams during the day. If I’m going against everything my body wants to do, sleep wise, I better at least be getting 7 hours a night..err..day.

4. Limit the coffee. After reading this great article by Mark Sisson, I’m going to keep my coffee to 2 cups per day when I get up and then switch over to tea. I tolerate coffee well but also don’t want to stress my adrenals more than they already will be.

5. Accept and be at peace. While working the night shift is far from ideal, there are a lot of positives that can come of it. Finding those positive aspects and accepting that this is my life for the moment will help keep my stress level low. I’m lucky enough to be working my dream job, full time and have benefits. Pretty awesome if you ask me!

Any night shift workers out there with any tips? Hooray for fellow zombie workers!

So by now you’re probably thinking, “wow this sucks….guess this is just how it’s going to be” NOT TRUE! There is a whole lot you can do to get better and feel better!

Let’s get to it:

1. SLEEP, SLEEP, SLEEP! For some reason just because you can survive, albeit poorly, on 4 or 5 hours of sleep people think it’s a good idea. It’s not, it’s a horrible idea and you will get fat and depressed. Lack of sleep causes all sorts of cravings, specifically sugary carbs. So now you’re tired, probably stressed, and you’re eating candy. Massive fail. Please go to bed. Just get in bed an hour earlier than you usually do, leave your computer in the living room and put your phone on silent. If you have an iPhone turn it over, when it lights but it is very bright. Try to get yourself on a solid sleep schedule, at least 7-8 hours every night. You will be amazed how much better you feel after a few weeks. Lastly, the theory that you can sleep in on the weekends and “catch up” on sleep is not true. It’s a load of crap.

2. Try going gluten free. Although it seems that going gluten-free is pretty trendy these days, about 50% of the US population (celiacdisease.about.com) could potentially benefit from it.

3. Cut the caffeine. No one needs to drink a Trenta size coffee from Starbucks. No one. However, since you’re exhausted and just trying to get through the day the coffee pot is calling your name all day. Resist it! Caffeine triggers the adrenals to release more hormones; you want them to rest, not work! Try cutting back a cup of day or switching to an herbal tea. You will give your adrenals a rest and be more hydrated.

Healing your adrenal fatigue can seem overwhelming so just stick to a few changes at a time. If three changes seem too much, just focus on one, sleep would be my recommendation! Good luck!

I don’t think hormones get the attention and respect they deserve; they are kind of like the passive-aggressive (or sometimes very aggressive) logistic coordinators of the body. EVERYTHING is controlled by hormones, especially in adrenal fatigue.

Let’s break it down:

Your adrenal glands sit on top of your kidneys like two little kidney hats. They are responsible for mediating stress responses and releasing specific hormones in charge of that.

Epinephrine and Norepinephrine – also known as adrenaline, these two hormones are your “fight or flight” directors. You know that feeling when you barely miss a dangerous situation, say rear-ending a car because you’re changing the radio? That dropping stomach, flushed face, shaky hands feeling? That is all because of an instant release and response to adrenaline!

Side note – stress doesn’t have to be just an acute situation. Unfortunately, our lives are more about chronic stress than having to run away from a lion cave-man style. As I mentioned previously, we were built to deal with acute stressors followed by a period of long rest, not the constant stress we deal with in modern lives.

Cortisol – I’m sure everyone has heard those BS diet commercials talking about the connection between cortisol and belly fat, well, part of that is true but the rest of it is garbage (don’t take diet pills. Ever.). The adrenals release cortisol in response to, you guessed it, stress!

-tells the liver to release sugar in to the blood

-raises blood sugar (so you can run away from that lion that is trying to kill you, not sit in traffic)

-suppresses the immune system

These are just a few of the things cortisol does, but, clearly it is a very important hormone but not so good when it is being released all the time. Ever wonder why people seem to be running themselves ragged and then end up sick? Thank cortisol.

These few hormones are just the tip of the adrenal ice berg. Next post I’ll explain the brain connection to all of this…I promise I’ll get to how to fix it!

We’ve all been there; you’re exhausted but can’t sleep. You stare at the ceiling and get legitimately mad at your dog/cat/partner for sleeping while you’re awake, hey if you’re up everyone should be up right? Just kidding. Sort of.

Unfortunately a lot of people head to their doctor and get a prescription sleep aid as a band-aid to their problem instead of investigating the actual cause.

Anyone ever heard of adrenal fatigue? Unless you’ve done some independent googling or spent some time in the holistic medical community you probably haven’t.

Our bodies are built to deal with acute, intense stressors for a short period of time followed by a long period of rest and recovery. So in real life, you head to CrossFit and do a 15 minute intense work out but then you chill out for the next 24 hours. When people are sleeping well, have a healthy gut, and minimal stress or effective stress coping techniques your body handles this great, it was built to!

However, if like most Americans, you are not sleeping enough, eating crap and experiencing long-term chronic stress you probably have some sort of adrenal fatigue. It’s that tired and wired feeling. You so desperately want to sleep but can’t. When you do finally sleep, morning comes way too fast and you can barely stumble out of bed in the morning. Oh yeah, and don’t talk to you until you’ve had your venti Starbucks. Sound like you?

In my next post I’ll breakdown the key hormone players and some things you can do to FEEL better, isn’t that what we all want anyways?

The holidays are a notoriously stressful time for everyone, so I’ve come up with a list of things I do to try to keep my sanity.

1. Say no and stick to it.

One of the biggest things I’ve learned is to know your boundaries and stick to them. There are an insane amount of social opportunities during the holidays so pick some that are really important to you and go! If there are others that you feel obligated to go to or just don’t want to, stop by for a little bit or politefully decline the invite. There is nothing wrong with saying no! I promise, once the guests have a few eggnogs in them they won’t notice if you stayed for 30 minutes or 3 hours.

2. Protect your work out/alone time.

As I’ve said, since the holidays are stressful and you are often pulled in many different directions it is SO important to protect some time every day for just you. This is the time to do your work out or veg out and catch up on Dexter. Just a side note, please do not underestimate the effect stress has on our bodies. I always tell people to err on the side of rest during exhausting times. For example, if you normally run a few times a week, try walking or yoga instead.

3. Eat like you know you should.

Just because it is a festive time of year that doesn’t mean you should face-plant into a goblet of spiced wine and that questionable, gross, from-a-package onion dip YUCKKKK! Eat a vegetable every day. Now do it again. Now again…oh wait you’re eating like you do the other 10 months of the year. Good work!

4. Keep a budget.

Gifts are expensive. I have the budget of a fruit fly, so this year, I’m going the homemade route for most of my presents. People know how much thought, time and effort goes in to homemade gifts so I really believe they are more meaningful than a pair of China town earrings of a stupid fruit cake (which really, who eats one of those??).